Symptoms and Signs

Pain and swelling at the front of the shoulder or back of the upper arm or down to the wrist

Weakness in the arm during forward lifting and twisting the arm inwards

Decreased range of motion in the shoulder

Increased passive external rotation of an arm

Pain during tests

References: [2,4]

Tests

Tests for subscapularis tear (see Video 1 and Reference [4]):

Resisted medial rotation

Passive elevation of the arm

Horizontal passive adduction

Bear-hug test

Belly press test

Gerber’s lift-off test

A doctor can often make a diagnosis of subscapularis tear from symptoms and signs alone. The tear can be detected by arthroscopy, ultrasound and magnetic resonance imaging (MRI) but not by an X-ray [3].

Treatment

Transverse friction massage to prevent the development of scar tissue (adhesions) twice a week for 3 weeks to 3 months

Stretching exercises

Severe inflammation: 1 or 2 steroid injections (cortisone)

Chronic tear in older people: physiotherapy

Acute tear in active persons: arthroscopic repair or open surgery

Stretching Exercises

Stretching exercises are intended to prevent the development of scar tissue around the tendon. They have to be performed every day for 6-8 weeks in order to be effective [4].

Exercise 1 [4]. Lie on the bed face up. Grip a 2-5 pound weight and bend the affected arm in the elbow by 90 degrees. Lower the forearm away from the body (but not beyond the point of pain) and hold for 30 seconds. Repeat 5 times and have few moments of rest between each repetition.

Exercise 2. Do the same as in exercise 1, but instead of just holding the weight, keep raising and lowering the forearm for 10 seconds. Repeat 3 times.